Can Monitoring Make It Happen? An Assessment of How Reporting, Monitoring, and Evaluation Can Support Local Wellness Policy Implementation in US Schools

US school districts participating in federal child nutrition programs are required to develop a local wellness policy (LWP). Each district is allowed flexibility in policy development, including the approaches used for policy reporting, monitoring, and evaluation (RME). The aim of this convergent mixed-methods study was to quantitatively examine RME provisions in policies among a nationally representative sample of districts in the 2014–2015 school year in order to examine whether policies were associated with RME practices in those districts, and to qualitatively examine perceived challenges to RME practices. Data were compiled through the School Nutrition and Meal Cost Study and the National Wellness Policy Study. In multivariable regression models accounting for demographics, survey respondents were significantly more likely to report that their district had informed the public about LWP content and implementation, if there was a relevant policy provision in place. Having a strong policy (as compared to no policy) requiring evaluation was associated with reports that the district had indeed evaluated implementation. Having definitive/required provisions in policies was significantly associated with actual use of RME practices. RME activities are an important part of policy implementation, and these results show that policy provisions addressing RME activities must be written with strong language to require compliance. In interviews with 39 superintendents, many reported that RME activities are challenging, including difficulty determining how to monitor and show impact of their district’s wellness initiatives. Furthermore, the qualitative results highlighted the need for vetted tools that are freely available, widely used, and feasible for districts to use in assessing their progress toward meeting the goals in their LWPs.

Mobilizing Knowledge: A Comprehensive Toolkit for Quality Assured Nutrition Data and Piloting Gender Indicators

Objectives Nutrition International (NI) sought to standardize and add novel indicators to the multiple coverage surveys conducted each year on maternal, newborn, infant and child nutrition programs to assure quality and timely, gender-related data that meets next-generation monitoring needs. Methods In collaboration with Campbell Collaboration (CC) and University of Toronto (UT), NI developed a comprehensive step-wise survey toolkit with multiple intervention modules using a systematic process for selecting and contextualizing indicators (NI), validating data quality (NI-UT) and piloting gender indicators derived based on statistical modelling results using Demographic and Health Survey gender and nutrition related data (CC-NI). The resulting Nutrition Information Monitoring Systems (NIMS) toolkit now includes ODK formatted questionnaire templates, quality control and assurance checklists and ready-to-use SPSS syntax for data analysis and interpretation purposes. NIMS derives its results from household-level information through the following modules: zinc and Oral Rehydration Salts coverage for diarrhea treatment, maternal-newborn nutrition, weekly iron-folic acid supplementation among adolescent girls, and infant and young child nutrition – each with selected knowledge components and newly-devised gender-related questions to inform NI's nutrition-sensitive programs. Selected modules were implemented in NI's ten intervention countries 2019–20. Results Application of these procedures and quality metrics allowed NI program officers to: 1) systematically assess quality during data collection – identifying and correcting surveyor errors and potential sampling bias in a timely fashion, 2) validate and visually demonstrate data quality to relevant stakeholders, and 3) produce quality assured data within 1–3 weeks, compared to 1–3 months for previous surveys that did not use the NIMS procedures and tools. Conclusions This systematic approach facilitated reporting timely, quality assured nutrition program data to inform how NI interventions and gender-related analyses will identify how NI's programming can be more gender-responsive. Funding Sources CanWaCH, Global Affairs Canada and Nutrition International.

Beyond Funding

The Rural Child Poverty Nutrition Center (RCPNC) was created through grant funding from the United States Department of Agriculture Food and Nutrition Service and designed to address childhood food insecurity in persistently poor, rural counties in the United States. The RCPNC selected various community projects that focused on child nutrition assistance programs. Administration and technical assistance from the RCPNC allowed for improvements to child nutrition programs for the sub-grantees through the grant beginning with community needs assessments and programming meeting their individual needs. Evaluation found that the RCPNC was successful in assisting the sub-grantees reach their unique goals, which improve the initial outcomes as desired by the grant. Additionally, despite the unique communities the sub-grantees served, there were commonalities that linked all of the communities. This chapter describes the process with which the RCPNC sought unique communities with creative projects and explains the ways in which others can improve child nutrition outcomes.

Choice Architecture in Appalachian High Schools: Evaluating and Improving Cafeteria Environments

School meals are a primary source of nutrition for many adolescents. Determining factors that influence the selection of various foods can provide insight on strategies to improve students’ cafeteria choices. This evaluation and observation was conducted at three Appalachian high schools to assess the cafeteria environment. The study developed and implemented an assessment tool created using principles of choice architecture and behavioral economics building on the work of the Cornell Center for Behavioral Economics in Child Nutrition Programs (BEN Center). The assessment tool scored eight components of the lunchroom—the exterior, hot serving area, cold serving area, salad bar, beverage area, payment station, dining area and grab-n-go, where a higher score equals healthier components offered. High school (HS) #1 earned 73/128 points (57%), HS #2 earned 69/128 (54%), and HS #3 earned 53/102 (52%). HS #3 did not have a grab-n-go option and the final score was out of 102. Video observation was used to collect data on lunchroom activity during mealtimes. Each school received reports that highlight the results and suggest improvements to raise their score. The scoring tool represents a novel way to assess the health of school lunches, provide insights on how to improve the healthfulness of students’ lunch choice, and improve overall nutrition status.

Child Nutrition Programs in Kindergarten Schools Implemented by the Governmental Sector and Global Nutrition Consulting Companies: A Systematic Review

Child Nutrition Programs in schools are considered one of the best approaches towards improving diet and health. Yet it is considered a newly developed approach to be applied in Saudi Arabia. According to the ministry of health, under nutrition and obesity both are increasing in Saudi Arabia, due to various factors, which include both diet and environmental factors associated with schools and home environments. We have chosen a descriptive study to describe Child Nutrition Programs run by governmental sectors in United States and United Kingdom, in addition to global nutrition consulting companies in different countires, which included India and Singapore. The objectives of this review is to demonstrate successful Child Nutrition Programs approaches, strategies, tools, marketing plans and resources targeting pupils, parents, teachers and schools staff. Thus, this review supports implementing Child Nutrition Programs in Saudi Arabia, by choosing the most suitable strategies to improve child health and nutrition.